- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $2,630.27 / $8,317.64
| Facility | | $1,148.15 | $2,630.27 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,709.64 / $13,489.63 / $21,877.62
| Facility | | $8,709.64 | $13,489.63 | $21,877.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,803.84 / $13,803.84 / $13,803.84
| Facility | | $13,803.84 | $13,803.84 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,862.09 / $7,943.28
| Facility | | $1,096.48 | $1,862.09 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $4,677.35 / $8,709.64
| Facility | | $1,230.27 | $4,677.35 | $8,709.64 |